Saturday, November 13, 2010

Treating the Obliquus Muscles During Their Shortening Phases

If there were a button you could push on a person's body that would quickly cause deep relaxation, would you like to know about it? Extension of the occiput, taught in all beginning cranial courses, is magically tranquilizing. Most of the heads I cradle, however, are not willing to extend immediately. What is not taught in cranial courses is that most heads have issues with AA rotation and OA sidebending, preventing the normal extension and flexion movement at the occiput. Cranial courses teach you how to adjust the bones within the head, but not the head's articulation with the neck.

Chiropractor's offices are filled with people needing their atlas or axis adjusted. In fact, some Chiropractors adjust only the atlas, others adjust only the axis, and still their practices are full. These Chiropractors are so busy because releasing these two joints melts the whole body. It is likely that slow-motion cranial release is even more beneficial than thrust adjustments.

Cranial work also benefits the practitioner. Treating the OA and AA joints is fun, like solving a three-dimensional puzzle. Also, many of us were drawn to become therapists because we need to create more meaningful relationships. Responding to the person's cranial motion is like having an honest dialogue about the person's deeper issues. A friendship develops between your hands and the person's cerebellum.

Following cranial motion, however, means you have to give up control. If you want the person's head to return toward neutral, but their head wants to remain rotated, you cannot just move it. You have to let go of your need to fix them; it's not about your performance. Therefore, cranial work is also personal development; you practice patience, presence, non-judgment, vulnerability, curiosity, nonself-importance, and compassion. The benefits for the practitioner may be even greater than the benefits for the receiver!

Even if you have never tried following the cranial rhythm, I think you can get it. Here is the essence of the maneuver: Begin the massage with the person face up. Cradle their head in your hands. The AA joint allows rotation, the "no" motion. Let's say their head wants to rotate right. This means their nose would move to the right while the back of their head moves to the left. Since their head is resting on your hands, your hands have to slide to the left across the massage table. You help the head to purely rotate as much as it wants. If it wants to return to neutral, you help it, but if it wants to stay put, you wait. The waiting can take any amount of time. You may feel a twitch, then about twenty seconds later, the head may want to return toward neutral, and the joint is more relaxed.

The OA allows a small amount of "yes" motion, and also allows the cocking of the head, so that one eye lifts higher than the other. If you feel the head sidebending, help this motion to be pure sidebending without rotation. For example, if the top of their head were moving to the right, their chin would move to the left. Once the head has moved, you let it rest there while it thinks things through, and when it is ready, you may feel a twitch, then it begins to move back toward neutral.

You could quit reading now, and this would be enough instruction for you to learn cranial manipulation of the OA and AA joints. While you are practicing, the method teaches itself to you. You are your own best teacher!

The rest of the article is very technical; so don't expect to get it on the first reading. Still, there is much more technical information which may help you. First we will cover the structure and function of the OA and AA joints. Then we must study the muscles that control these joints. Finally I will walk you through an entire treatment. Practice on the people you massage, with the article open so you can refer to the drawings. Between practices, re-read the article. Training for this method is available but I really think you can learn it just by practicing with this article until you find your own inner guidance.


Learning the muscles is important for two reasons. When you palpate the involved muscle at the same time the head is in cranial motion, the joints resolve much sooner. Pure cranial work without palpating the muscle may require thirty minutes to treat the OA and AA joints, while adding muscle palpation reduces the time to an average of eight minutes.

Not only does pressing the muscle save time, it may be a more thorough resolution. When joints get "stuck," what binds them? Muscles. Cranial courses teach you that hydraulic pressures cause the motion. The first time you feel a muscle melt under your finger at the same time the cranial motion returns to neutral, you will believe that cranial motion must be caused by muscle contraction. Muscles have two sets of motor nerves, alpha and gamma. Guarding is present whenever the two nerves are sending incongruent messages to the muscle. Alpha nerves cause motion in the normal sense. Gamma nerves contract only the tiny muscle fibers within the muscle spindle proprioceptors. Gamma nerve enervation is not nearly strong enough to pull one bone closer to another. Gamma nerves are thought to be only necessary for coordinating motion. However, when we feel the head "wanting" to move to the right, what we are feeling may be the gamma contraction. Allowing the gamma contraction to accomplish its wish, by helping the muscle to shorten, its signal synchronizes with the alpha signal, so the muscle guarding disappears. This resolves inner conflict between incongruent brain activities, like thoughts, emotions, and behaviors.


There is no disc between C2 and C1. C2 sprouts a prong, and C1 is a ring-shaped bone that surrounds this prong.

C2 sprouts a prong, and C1 is a ring-shaped bone that surrounds this prong.

Atlanto-axial rotation is C1 rotating on C2, like a ring rotating on a finger. Head rotation occurs not between the head and C1, but between C1 and C2. Normal range of motion for head and neck rotation is 90 degrees. Of this range, the first 45 degrees comes from the AA joint alone while the last 45 comes from the lower five neck joints allowing about 9 degrees each.


When you feel the head "wanting" to rotate right, the muscle spindles of the obliquus capitis inferior on the right must be contracting more than on the left.

The obliquus inferior attaches the spinous process of C2 to the transverse processes of C1. These (use one, the two, or all three) photos show that in 45 degrees of right rotation, the right obliquus inferior is dramatically shortened while the left one is lengthened.

The textbooks may say that the other three suboccipital muscles are head rotators but I am skeptical. Certainly muscles that cross from C1 to the occiput cannot turn the head since C1 rotates with the head. This means obliquus superior and rectus capitis minor have no influence on AA rotation.

The only other suboccipital muscle that could rotate the head at the AA joint would be rectus capitis major, which crosses from the SP of C2 to the occiput. However, rectus major's insertion on the occiput is very close to the centerline, so it can only rotate the head 10 degrees. After 10 degrees, the rectus major begins to lengthen again, which means it would inhibit any rotation of more than 10 degrees. The problem with studying these muscles is that most photos and diagrams are shown in neutral, but we need to see them in right rotation.

This is all the rotation that the right rectus major can cause

The rectus major begins to lengthen again, proving that it would inhibit full AA rotation if it were contracting. Only the right obliquus inferior continues to shorten.

Clearly the right obliquus inferior is the one muscle that rotates the AA joint to the right. Sure, the left SCM can also rotate the head right. However, if the left SCM is contracting more than the right SCM, the cranial practitioner would not feel pure rotation, but rotation mixed with sidebending to the left. If you feel pure rotation to the right, the right obliquus inferior is the muscle that is contracting greater than its natural amount.


If the head rotates more than forty-five degrees, then the over-contracting muscle must be one of the extrinsic rotators like the trapezius, splenius capitis, SCM, or semispinalis capitis. However, when the person's head rotates more than forty-five, it is usually because the person is consciously engaging muscles to "help" you rotate the head. Conscious contraction feels much different than subconscious cranial motion; it is powerful and notchy while cranial motion is smooth and subtle. Cranial motion often rotates the person's head right up to forty-five degrees then stops there for a time. Keeping the right obliquus in its shortest position for ninety seconds may balance its contraction. You may feel a twitch, then the head wanting to return to neutral. Rubbing, then pressing the obliquus inferior while it is shortening will be even more effective.

If the head rotated to the right, now the weight of the head is on your right hand. Your left hand is free. Use your middle fingertip to find the obliquus inferior. (look ahead to the next picture) Since the muscle is very small, first find the origin and insertion, and then press halfway between. Your left fingers will reach under the neck, palpate the spinous process (SP) of C2, and reach farther under. If you can find the transverse process (TVP) of C1, great! However, this is difficult to palpate accurately, even though it is the largest TVP. If you can't feel the TVP, then palpate the mastoid process of the temporal bone (since the head and C1 rotate together, the TVP of C1 is very close to the mastoid process). Press halfway between the origin and insertion, and using a diagonal (cross-fiber) motion, discern the fibers of the obliquus inferior. Even if you cannot palpate the fibers on your first try, I know you can press halfway between the two bones, so don't worry, you are pressing in the right place.

Use cross-fiber strokes whenever a muscle is in its shortening phase. If the muscle stops in its shortest position, stop the rubbing motion and press into the bulge of the contracted muscle.

Then you wait. You may feel one of two things: either the head will begin to rotate back toward neutral, which you will monitor with your right hand, or you will feel a softening under your left middle fingertip. Using two hands in partnership like this adds a new dimension to the therapy. If the first response you feel is the motion of the head, then respond by helping the head return to neutral with your right hand, while still palpating the muscle with your left hand. If the first response you feel is the softening of the muscle, follow the sinking with your left fingertip while still monitoring the head motion with your right hand.

As the head begins to rotate back toward neutral, the person's nose will move left. You must help the back of their head move to the right to maintain pure rotation. Your left fingertip is still pressed into the obliquus. Curl this finger so that it is preventing C2 from following the back of the head to the right. Press your left thumb against their head, squeezing your thumb and fingertip slowly closed as the head rotates, ensuring that C2 does not rotate to the right with the back of the head.

The head's weight is on the right hand, leaving the left middle fingertip free to monitor and press the right obliquus inferior. Once the head begins returning toward neutral, use the fingertip to prevent C2 from moving right with the back of the head.

Even if you do not pin C2, even if you are not sure you are really palpating the obliquus inferior, just following the motion of their head is very therapeutic. You will get the more subtle parts of the maneuver in the months ahead as you practice.

Once you have felt a release on one or both sides, the AA joint may want to again rotate right, then left, then right, using up precious time. The cerebellum may be stuck in a rut. It may be time to move on. The next time the head rotates to neutral, stop the rotation and apply a firm extension to the head, to begin the next maneuver. Once extension had begun, let the head float to see which direction it will go. Guiding the motion is okay for a few seconds, but then listen for the person's cerebellum telling what is most important on its agenda.


There is no disc between C1 and the occiput. C1 provides two supporting bowls and the occiput has two curved posts that rest in these bowls, like two mortar-in-pestles.

Some anatomists speak of the OA facets as opening and closing. A facet opens when the two bones come away from each other, the distance that the ligaments allow. Since these facets are at the front of the spine, both facets would open when you tilt your head to look up (extension), and both facets would close if you tilt your head to look down (flexion). If you cock your head so that your right eye is higher, the right facet would be open while the left one would be closed. Seeing the curved shape of these facets, you may wonder if, instead of opening and closing, the posts slide forward, backward, and side-to-side in the dishes. Probably some combination of sliding and opening takes place.


Because the OA joint can flex, extend, tip left, tip right, tip left in extension, tip right in extension, tip left in flexion, and tip right in flexion, there are many muscles to consider. When the head "wants" to tip right in extension, for example, the rectus capitis posterior major, minor, and the obliquus capitis superior on the right are contracting stronger than the ones on the left. When the head tips right in flexion, the suprahyoids are contracting more on the right. The SCM does not tip the head forward or backward on the OA joint. While the SCM can pull the whole head and neck forward, the head will remain level.

Therefore, when the SCM contracts it cannot rock the head forward or backward on this joint. If the SCM is contracting greater on one side, this sidebends the head at the OA joint, but the sidebending would not be accompanied by flexion or extension of the head--instead, the sidebending of the OA joint would be accompanied by rotation to the opposite side.


If you don't feel any motion the moment you cradle the head, apply some force to tip the head back (chin rising) for five or ten seconds and forward (chin dropping) for ten more, back and forth every ten seconds in a very gentle rhythm. While you are causing this motion, be responsive to other motions that the person's head would rather move. For example, I often find that when tipping the head back, it cannot go fully back unless it also sneaks into a sidebend. If full back-and-forth motion is present for several repetitions with no side-tipping or rotation, then it is time to move on to the rest of the body.

When you feel tipping to the right, help it tip even more. Pure OA sidebending means that the forehead moves to the right, the nose remains in the same place, and the chin moves to the left. When you feel the head moving right, guide the chin left. Once the OA has come to its limit, the motion will probably stop there for a while. The sidebending may occur in flexion, in extension, or neutral.

When the head tips right, the nose remains in the same place while the forehead moves right and the chin moves left.

Keeping the over-contracting muscle in its shortened position for about ninety seconds, the incongruence may resolve. You might feel a twitch, then the head wanting to return to neutral. Rubbing the muscle while it is shortening, then pressing while it is stopped in its shortest position, accelerates the process dramatically.

Here is a list for which muscles to rub while the head is moving into various positions:

Muscle palpation cheats (to the right):

While tipping R in flexion, R suprahyoids

While tipping R in extension, R suboccipitals

While extending, suboccipitals on both sides, and all larger muscles that attach to head (traps, splenius capitis, and semispinalis capitis)

While flexing, supra-and infra-hyoids on both sides

While tipping R and sidebending L at the same time, R SCM

While sidebending the whole neck to the R, or while sidebending R and rotating R at the same time, R levator, R splenius capitis, R semispinalis capitis and R traps

While rotating R up to 45 degrees, R obliquus inferior

While rotating past 45 degrees, R levator, R splenius capitis, R semispinalis capitis, R traps, and L SCM.


Have the person lying face-up on a massage table with their head in your hands, supporting it as if it were floating in water. Close your eyes and relax. Your wrists should not bend backward or forward but remain in line with your radius bone. Within three seconds, the person's body is already showing you which way the head would like to rotate, tip, flex, or extend. If you don't feel it yet, fake it. Lift the occiput, causing the head to tip back (chin rising) for five or ten seconds and forward (chin dropping) for ten more, back and forth every ten seconds in a very gentle rhythm. You lead at first, and then follow. While you are causing this motion, be responsive to other motions that the person's head would rather move. If regular back-and-forth motion is present for several repetitions with no side tipping or rotation, then no maneuver is necessary today.

I find rotation is usually the first motion to correct. If the head wants to rotate to the right, guide the back of the head to the left to keep the rotation pure. Palpate the right obliquus inferior, which is now shortening. Rub it while it is shortening, and when it has rotated fully and stops, press this muscle. You may feel the muscle soften, the head returning toward neutral, or both.

When the head begins to return to the center, allow this movement by sliding the occiput back across the table. Hold C2 while the head is returning toward neutral. When the nose is straight up again, the head will tend to rotate the other way, often because the person thinks it should. Gently prevent the head from rotating again, and instead, push up on the occiput slightly, making the chin rise, to see if the head will extend and flex in a slow rhythm.

Once rotation is balanced, the head may tip to one side at the OA joint. Palpate and rub the muscle that is shortening. You don't have to remember the names of the muscles to do this. If the head is tipping backward and to the right, the muscle must be on the back right side of the head. While the head is tipping right, guide the chin to the left to maintain pure sidebending without rotation. If the motion stops while tipped to one side, press that muscle more firmly. Pressing the exact muscle that is over-contracting accelerates the release.

Once the head will tip backward and forward in rhythmic, smooth, slow motion, it is time to move to the rest of the body. Your curved hands are two question marks, asking nonverbal questions that help the person express the unspoken.


Once you are facile with the OA and AA, you will be able to feel the same motions acting at different joints. Any neck vertebra, C2 through c6 can flex, extend, rotate, or sidebend on the vertebra below it. You will soon be able to feel that the fulcrum of the motion is lower in the neck. When you feel sidebending between C3 and C4, for example, make a fulcrum with your fingertip so that the sidebending will be more specific. Coincidentally, exactly where you make the fulcrum will be the place you need to palpate and press to release the muscles there.


The technique is finished if the head will flex and extend at the OA joint in a normal rhythm without sidebending or rotating. What if the OA and AA do not resolve in ten minutes? I'll tell them that their neck could use more help, and ask if they want to use more time now to pursue a resolution, or schedule another massage to focus more on the neck. Often the person is in an altered state within ten minutes, and would love to spend another fifty minutes going deeper.

Patrick Moore travels Nationwide as an NCBTMB educator for massage therapists, and practices massage in Phoenix, AZ. In 2001 he discovered Melting Muscles--guarded muscles relax when the brain feels safe. A specialist in the Obliquus muscles that control the atlas and axis of the neck, his articles have appeared in Massage & Bodywork magazine and Massage Therapy Journal. Please visit or

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